Crain's Chicago Business | What a dying patient taught me about the limits of medicine Crain's Chicago Business (STAT)Propelled in part by the unalloyed hopes I cultivated in medical school, I got through my internal medicine residency training largely free of questions about medicine's limitations. Ailing strangers entered my life in the hospital, and I ... |
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What a dying patient taught me about the limits of medicine - Crain's Chicago Business
Going hungry for 5 days a month may improve your health.
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By Mitch LeslieFeb. 15, 2017 , 2:00 PM
Fasting is all the rage. Self-help books promise it will incinerate excess fat, spruce up your DNA, and prolong your life. A new scientific study has backed up some health claims about eating less. The clinical trial reveals that cutting back on food for just 5 days a month could help prevent or treat age-related illnesses like diabetes and cardiovascular disease.
Its not trivial to do this kind of study, says circadian biologist Satchidananda Panda of the Salk Institute for Biological Studies in San Diego, California, who wasnt connected to the research. What they have done is commendable.
Previous studies in rodents and humans have suggested that periodic fasting can reduce body fat, cut insulin levels, and provide other benefits. But there are many ways to fast. One of the best known programs, the 5:2 diet, allows you to eat normally for 5 days a week. On each of the other 2 days, you restrict yourself to 500 to 600 calories, about one-fourth of what the average American consumes.
An alternative is the so-called fasting-mimicking diet, devised by biochemist Valter Longo of the University of Southern California in Los Angeles and colleagues. For most of the month, participants eat as much of whatever they want. Then for five consecutive days they stick to a menu that includes chips, energy bars, and soups, consuming about 700 to 1100 calories a day.
The food, produced by a company that Longo helped found (but from which he receives no financial benefit), is high in unsaturated fats but low in carbohydrates and proteins, a combination that may spur the body to restore itself and burn stored fat. Two years ago, Longos team reported that mice on the rodent version of the diet lived longer and exhibited other positive effects, such as lowered blood sugar and fewer tumors. They also presented preliminary data suggesting health benefits in humans.
Now, the researchers have completed a randomized clinical trial in which 71 people followed the fasting-mimicking diet for 3 months, while volunteers in the control group didnt change their eating habits. Overall, the dieters lost an average of 2.6 kilograms (5.7 pounds), whereas the control group remained at the same weight, the scientists report online today in Science Translational Medicine. The calorie cutters also saw reductions in blood pressure, body fat, and waist size.
A 3-month trial cant determine whether the diet increases longevity in people like it did in mice, which rarely survive beyond a couple years. But Longo notes that levels of insulin-like growth factor 1, a hormone that promotes aging in rodents and other lab animals, plunged in the low-cal group. And subjects who were at the highest risk for age-related illnesses also saw other indicators of malfunctioning metabolism go down, such as blood glucose levels and total cholesterol.
Longo says that this diet treats aging, the most important risk factor for killers like diabetes and cardiovascular disease. It looks like you can go at the underlying problem rather than just putting a Band-Aid on it, he says. In a follow-up trial, the team hopes to determine whether the diet helps people who already have an age-related diseaseprobably diabetesor are susceptible to one.
Dieting is often hard, but 75% of the low-cal participants managed to complete thetrial, notes gerontologist Rafael de Cabo of the U.S. National Institute on Aging in Baltimore, Maryland, who wasnt involved with the work. The next step, saysphysiologist Eric Ravussin of the Pennington Biomedical Research Center in Baton Rouge, is todetermine whether the dietalsoworks in people who are not as healthy as they used in this study.
Research dietitian Michelle Harvie of the University Hospital of South Manchester in the United Kingdom adds that she wants to see longer studies confirm that the benefits persist and that people remain on the regimen. We need to help a lot of people, but what if only 2% of them are willing to do this?
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Five-day fasting diet could fight disease, slow aging - Science Magazine
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How an orchestra uses space in a time-critical context can hold lessons for surgical teams.
Analytical chemist Matthew Lewis had a problem: when he tried to bisect kidney stones for analysis by mass spectrometry, they crumbled. Glass artist Katharine Coleman suggested a solution, using lens-grinding equipment mounted on a portable lathe. With this, the kidney stone could be gently abraded to produce a clean equatorial section. As Lewis (who works in the Division of Computational and Systems Medicine at Imperial College London) put it: An epiphany for me was that the tools Katharine works with are more suited to our application than our own.
Nearby, at the Imperial-run St Mary's Hospital, embroiderer Fleur Oakes has identified techniques from her repertoire that could improve surgeons' control over fine sutures when they join arteries together. Oakes lacemaker in residence at the vascular-surgery unit is working with the clinical team to devise an educational programme aimed at overcoming problems with thread tangling during surgery.
These cross-cutting collaborations are part of the engagement and performance science programme that I direct at Imperial. Under its aegis, bioscientists and clinicians in the divisions of computational medicine and surgery are working with expert practitioners and academics from the Art Workers' Guild, the Royal College of Music and the Victoria and Albert Museum Research Institute to explore common ground in haptic learning how we discover through doing in science and craft (J. Kiverstein and M. Miller Front. Hum. Neurosci. 9, 237; 2015). Science and medicine are no more purely cognitive than the arts. All depend on performance, technical skill, observation, dexterity and the ability to work under pressure.
Over more than ten years in this arena, I have learned that the conditions for serendipitous encounters must be deliberately curated. The Imperial programme is not a conceptual scienceart collaboration, whose benefits for scientists are often considered marginal. It hinges instead on physical communication at the level of doing and making the craft of science. We have found that the collaborations have led to changes in approach, such as heightening surgeons' awareness when handling suture thread, as well as inspiring experimentation with new stitching techniques. Engaging with different experts can send a cold blast through our assumptions, scouring them out and leading to new insights.
Rachel Warr is revealing the value of puppetry to surgery, for instance. A leading freelance puppetry director and artistic director of London's Dotted Line Theatre, she has shown how puppeteers start rehearsals with a sequence of hand and finger exercises to prepare them for the intricately dexterous work of manipulating rods or marionette strings. Similar routines could be applied to surgery to enhance finger control and precision. Pre-performance group warm-ups could improve surgical teamwork.
The BBC Symphony Orchestra's principal percussionist, David Hockings, has shown how he interacts with fellow musicians and their instruments on a narrow platform, collaboratively negotiating space in a time-critical performance. Using complex contemporary music Lera Auerbach's The Infant Minstrel and His Peculiar Menagerie he has also revealed how individual experts create new ensembles to perform challenging tasks under pressure. That highlights parallels with 'transient teams' in surgery, where surgeons, anaesthetists and nurses must forge collaborations quickly for high-stakes operations.
Close-up magician Richard McDougall (a Gold Star Member of Britain's Inner Magic Circle) is working with a neurosurgical team at St Mary's led by neurotrauma specialist Mark Wilson. Learning even simple tricks demands much practice: the performer must perfect the choreography of fine motor skills and engage with the audience. McDougall and Wilson will be teaching magic techniques to people in rehabilitation after sudden head injuries, as a motivational adjunct to more conventional therapies.
These collaborations are already showing their value. In time, some may have demonstrable impact on scientific and medical practice. They are experiments, of course, so uncertainty is built in. But intention to collaborate and think differently lies at their heart.
Science and medicine can develop a seductive self-sufficiency, a belief that everything that must be learned can be found in their specialized worlds. Engaging directly with the practice of craftspeople and performers reveals another way.
Knowledge in the arts, crafts and trades has been devalued by successive governments. School curricula have been hollowed out in the belief that doing and making are subordinate to thinking. Collaborative university programmes are being cut or curtailed, and generous-minded exploration between disciplines is under threat. Yet doing and thinking are two sides of the same coin. It is in all our interests to cherish and protect what can all too easily become lost in description the enduring craft of science and medicine.
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The Brookhaven Police Department announced Wednesday it was awarded a grant for a drug collection unit as part of CVS Healths Medication Disposal for Safer Communities Program. The new unit will be located in the lobby of the Police Department headquarters at 2665 Buford Highway and will provide residents with a safe and environmentally responsible way to dispose of unused or expired controlled substances. The collection unit is open to the public 24 hours a day, seven days a week, and drugs can be dropped off with no questions asked, reducing prescription drug abuse and contamination of local landfills and water supplies from unused medication.
Safely disposing of unused medication is critical to preventing prescription drug abuse and keeping pharmaceuticals out of our waterways, said Brookhaven Police Chief Gary Yandura. The Brookhaven Police Department is proud to partner with CVS Health and we thank them for their commitment to helping residents reduce the amount of unneeded medicine in our community.
Information: http://www.brookhavenga.gov; 1-866-559-8830.
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Brookhaven Police offer medicine disposal collection unit - Atlanta Journal Constitution
New York Times | A Canadian City Thrives on Gas, Like a 'Wealthy Little Country' New York Times Now, Medicine Hat is setting up the equivalent of Norway's famous sovereign wealth fund, a pool of money that should make more money for generations to come. We could separate from the world, and we'd be totally self-sufficient, said Ted Clugston ... |
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A Canadian City Thrives on Gas, Like a 'Wealthy Little Country' - New York Times
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Paul Ryan: Democrats Want To Go Down 'Socialized Medicine Path' - TPM
The stock market continued to climb sharply on Wednesday, sending major market benchmarks to record highs yet again and propelling the Dow Jones Industrials up more than 100 points. Economic data continued to support the notion that the U.S. economy remains strong, and rising inflation levels led many to conclude that the Federal Reserve is more likely than ever to follow through on its promise to keep lifting short-term interest rates in 2017. Rising bond yields reflected investors' reluctance to hold onto fixed-income investments in anticipation of higher rates, prompting some to shift assets into the stock market. Several companies also reported, andFortress Investment Group (NYSE:FIG), Editas Medicine (NASDAQ:EDIT), and Hertz Global Holdings (NYSE:HTZ) were among the top performers on the day. Below, we'll look more closely at these stocks to tell you why they did so well.
Shares of Fortress Investment Group soared almost 30% after the investment specialist received a takeover bid from Japan's SoftBank. The terms of the $3.3 billion buyout involve Fortress Class A shareholders receiving cash of $8.08 per share, and in addition, shareholders will be entitled to receive dividend payments for the fourth quarter of 2016 and the first quarter of 2017 if the transaction doesn't close before the latter payment is due. As part of the deal, key leaders at Fortress have agreed to stay on, and the company's principals have agreed to invest at least half of their after-tax proceeds from the sale into Fortress-managed fund offerings. SoftBank CEO Masayoshi Sun said that his company "looks forward to benefiting from [Fortress'] leadership, broad-based expertise, and world-class investment platform," and the Japanese company expects Fortress to contribute toward its overall growth objectives.
Image source: Getty Images.
Editas Medicine stock climbed 29% in the wake of its announcement of a favorable intellectual property decision. The genome-editing company said that the U.S. Patent and Trademark Office issued a favorable decision in a case involving patents that Editas licenses from the Broad Institute. A dispute between MIT and Berkeley regarding the patents had threatened to put a stop to some of the work that Editas was doing, given that Berkeley scientists had developed technology that Broad Institute used to evaluate gene editing in certain specific cases. In the ruling, the U.S. PTO ruled in favor of Broad Institute's request for no interference in fact, a legal term of art that allows Editas to keep using CRISPR-Cas9 patents as part of its fundamental genome-editing work. By ensuring that Editas will be able to continue its work, the ruling gave investors hope for future breakthroughs unhampered by the need for further licensing.
Finally, shares of Hertz Global Holdings rose 7%. The rental car giant got good news in the form of an increased ownership stake from well-known activist investor Carl Icahn. Icahn reported in his quarterly disclosure of investment holdings that he had raised his investment in Hertz to 29.3 million shares, more than doubling his previously reported position. That gives the activist investor about a one-third stake in Hertz, and it will be interesting to see to what extent Icahn pushes Hertz harder to take steps toward getting its shares back on track. The rental car specialist's shares are down 60% just since September, and many expect more aggressive action from Icahn in the near future.
Dan Caplinger has no position in any stocks mentioned. The Motley Fool owns shares of Hertz Global Holdings. The Motley Fool has a disclosure policy.
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Why Fortress Investment Group, Editas Medicine, and Hertz Global Holdings Jumped Today - Motley Fool
Registration has opened for the spring term of Crispus Attucks Community Academy. Faculty from local colleges will lead five classes ranging from capitalism to race and medicine.
The classes meet weekly for six weeks at Crispus Attucks Community Center at S. Duke Street and Howard Avenue.
The fee is $25 per course. No exams are given.
For information on registering, call 717-394-6604, ext. 120, between 1 and 5 p.m. weekdays.
Capitalism: What it is, how it works taught by Antonio Callari of Franklin & Marshall College 7 to 8:20 p.m. Tuesdays March 21 to April 25. Topics include markets, wages, poverty and inequality.
The Black Woman taught by Rita Smith-Wade-El of Millersville University 6 to 7:20 p.m. Wednesdays, March 22 to April 26. The course looks at issues confronting black women in non-Islamic Africa and the United States.
Africa Before Colonialism taught by Onek Adyanga of Millersville University 7:30 to 8:50 p.m. Wednesdays, March 22 to April 26. Topics include theories of African societies, migrations, civilizations and cross-cultural contacts.
Race, Medicine and Social Justice taught by Ashley Rondini of Franklin & Marshall College 2 to 3:30 p.m. Thursdays, March 23 to April 27. Topics include health consequences of racialized public policies and racial and ethnic health disparities.
Colonialism: Culture, Economics and Power taught by Eimam Zein-Elabdin of Franklin & Marshall College 7 to 8:20 p.m. Thursdays, March 23 to April 27. Topics include colonialism as a system of control, with a primary focus on Africa, and the continuing effects of colonialism.
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Professor of medicine Drew Weissman said that vaccines that require multiple doses are hard to implement in areas with poor infrastructure because it can be hard to ensure people get their follow-up vaccinations.
The Zika virus may be mostly out of the news after its summertime peak, but Penn Medicine is still actively working to combat the spread of the disease.
A new vaccine developed at Penn Medicine could provide long-term protection against the Zika virus with just a single, relatively low dose. The virus continues to affect 76 countries in Central and South America and the Caribbean, with isolated local transmission cases in Florida.
Unlike other vaccines currently being developed, this new immunization does not use live viruses, which tend to cause adverse side effects and are not effective for those who have already been affected by the virus.
The new vaccines uses tiny strands of RNA that hold the genetic codes for making viral proteins that block Zika infection.
Drew Weissman, professor of medicine at the Perelman School of Medicine and senior author of the report on the new vaccine, said vaccines that require multiple doses are difficult to implement in areas with poor infrastructure.
The population that you would immunize right now is across South America, and much of that is very poor regions without much infrastructure for medical care, so if you had to give a vaccine twice or more, you would have to set up clinics and ways of following people to make sure everybody got immunized with two doses, Weissman said.
With a single dose, you go in, you find everybody, you immunize them once and youre done, he continued.
Up to this point, the vaccine has been tested on lab mice and monkeys. Human clinical trials are expected to start within 12 to 18 months.
The most important finding of this paper is that the vaccine is safe, Norbert Pardi, research associate and co-author of the report, said. We didnt see any side effects after vaccination in mice and monkeys.
Pardi also noted that the vaccine is protective after a single immunization with a relatively small dose.
This is very important [that] there is long-term protection, Pardi said. Many times, the problem with vaccines is that we get some protection for a while but after months or years, you have to be vaccinated again.
Weissman said this type of vaccine could be applied to other diseases, including influenza, HIV and malaria.
The research involves collaboration with lab researchers at Duke University and the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.
Theres a lot of potential to move [the vaccine] into a lot of different directions, he said.
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The Daily Pennsylvanian | Penn Medicine has developed a vaccine ... - The Daily Pennsylvanian
The Continuum Center for Health and Healing on First Avenue in New York City was a pearl among the large integrative medicine centers that were sponsored by medical delivery organizations in the first years of the integrative era. First conceived in 1998, an estimated $10-million in philanthropic funds directly backed the construction and supported clinical services. The clinic's leaders included Woodson Merrell, MD, Barbara Glickstein, RN, MPH and Ben Kligler, MD, MPH.
The work at the Continuum Center was leading edge. The team fostered a high level of interprofessionalism and team care. They generated an important body of research. They experimented with business models and experienced times of profitability. Yet amidst a larger economic drama of what was called a merger between Continuum Health Partners and the now dominant Mt. Sinai Medical Center, the formerly 32-clinician integrative center, with its 6,000 visits per month, was put on the corporate chopping block last fall.
To gain an understanding of what took place, I contacted Merrell, pictured above, who left his position prior to the decision, and Kligler, who had already accepted a new position with the Veteran's Administration's integrative health initiative prior to Mt. Sinai's closure decision. Glickstein left early on.
In a short interview, Merrell spoke to how significantly new leadership or corporate culture can shift an integrative center's stature: "A vice president of the (former) Beth Israel leadership described us as a 'crown jewel' of the system. We were drawing a high percentage of new patients to the system. We got great reviews from patients for our care. Now Mt. Sinai is taking a more limited view of how to assess value, focusing on RVUs [relative value units]. They clearly didn't see the value in the center."
Kligler and I spoke at length about the turns of events leading to the decision. At the core of our exchange was the vulnerability of these stand-alone clinics amidst leadership changes and system mergers. I shared that I had recently interviewed his frequent colleague, University of Arizona Center for Integrative Medicine's executive director Victoria Maizes, MD about the shutdown of ACIM's Phoenix-based integrative health clinic. Maizes had referenced what she viewed as a parallel with the Continuum story. In both cases, the clinics seemed to be collateral damage to a larger merger with a dominant player who didn't have much interest in the field. (That interview is here.)
Kliger began by sharing a perspective from the Continuum partner, Beth Israel, with which the clinic was most directly associated: "From Beth Israel there was a long-time commitment to the idea of integrative health and of integrative health having value to the system. There was always pressure about the business model but there was never a question that integrative health had more value to Beth Israel than just the stand-alone clinic."
Kligler was vice chair and Merrell chair, for instance, for an associated Department of Integrative Medicine, formed in 2007. The Center's robust activities hit on all three of the research-education-clinical care sweet spots. They had not only an Academic Fellowship in Integrative Medicine but also an inpatient acupuncture fellowship. Kligler secured a series of major federal research grants.
This was a remarkable track record of local and national engagement. Yet, Kligler added, "we never got a message from Mt. Sinai that integrative health as a clinical service was important to them."
Kligler quickly clarified that he "totally understands how it looks from [Mt. Sinai's] point of view. We just looked like another practice in a hospital that was losing money." He shared that the termination of operations is part of the territory. Mt. Sinai is also ending Beth Israel's service as a general hospital. "Some systems have integrative health in their core clinical mission," Kligler says, adding, with finality: "Others don't."
Kligler views the loss of the Center as "just bad luck." Why? "[Mt. Sinai] came in when we were the most vulnerable." Had the merger come through a couple of years earlier, it would have been when the center "was booming."
Kligler explains. In 2012, demand exceeded the ability to fulfill on meeting patient interest. The Center was operating profitably and expanded to a third floor. New investment coupled with new practices not yet overflowing added up to a temporal moment of significant red ink. Had the merger come later, in Kligler's view, the new configuration would have had time to fill out and flourish. Mt. Sinai caught the snapshot of that moment's performance rather than considering a promising revenue trajectory. Kligler summed up his view: "Honestly, we can't hold Sinai responsible. It was terrible timing."
Mt. Sinai's integrative clinical services will not be fully terminated. A core of 4 physicians will re-locate to a clinic across Manhattan in the West Village. Some are pushing the system to keep some of the non-MD practitioners associated. Research grants and education initiatives have been moved to the Sinai Department of Family Medicine, reflecting the fact that Sinai remains supportive of research and education in integrative medicine, reports Kligler.
Meantime, the Department of Integrative Medicine has not been terminated. Kligler, who applied in August 2015 for his current new position as the National Director of the Integrative Health Coordinating Center at the Veteran's Health Administration, maintains a role in research as principal investigator on three projects. How well these will survive the departure of Kligler's driving energy is yet to be seen, especially as the curret research grants come to an end.
Kligler noted that "health systems tolerate losses in many areas, for all kinds of reasons - primary care for instance." While typically losing money, primary care serves as a funnel for more lucrative tertiary care operations.
I asked Kligler his views of what Mt. Sinai lost in their decision to shut the Center. He spoke first of the group of patients "for whom integrative health is important." He then considered the loss to students and residents to experience integrative practices on such a large scale through their rotations through the interprofessional and multidisciplinary Continuum Center. Mt. Sinai lost, he concluded "the opportunity to envision a healthcare system that brings a wider range of tools and practitioners to the treatment of patients."
This article is one in a series on significant ups and downs with major centers. We see significant expansion at Jefferson in Philadelphia, a new 17,000 square foot space for the Center for Functional Medicine at the Cleveland Clinic, and system-wide integrative health at Meridian Health. The build-up of integrative health and research in the Veterans Administration with which Kligler is now involved is another bright light.
Meantime, on the deficit side: the shutdown of the Banner/Center for Integrative Health in Phoenix which was intended as a proving ground for integrative care; the Allina/Penny George Institute shut its research department and limited its inpatient program; and while not a clinical site, the Samueli Institute, an engine of integrative health research, also announced that it is ending operations.
I am still digesting the meaning of all these changes. One reasonable conjecture is that the lack of discussion in the Trump administration of the need to move to from "volume to value" that is promoted in some ways through the Affordable Care Act will make the medical industry even less hospitable to integrative services.
What is certain, however, is that as Continuum's robust research output winds down, the real world, institutional research base for integrative health - with the losses here, at Penny George, Samueli Institute and in Arizona - is on the ropes. Who and what will step up?
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Mt. Sinai Merger Shuts New York's Integrative Medicine "Crown Jewel" - Huffington Post
Jeff Charis-Carlson , jcharisc@press-citizen.com Published 5:20 p.m. CT Feb. 14, 2017 | Updated 15 hours ago
University of Iowa professor John Murry leads a seminar for medical school students at the Beisner Auditorium in the Bowen Science Building on Saturday, Feb. 11, 2017.(Photo: David Scrivner / Iowa City Press-Citizen)Buy Photo
What do the business histories of greeting cards and filtered water have to do with the practice of medicine?
Both help explain to future physicians how, when thinking about the future of medicine, they need to look beyond the limited field of their own expertise.
In the 1990s, for example, Hallmark and American Greetings discovered they had a lot less to worry about from each others market share than they did from their customers deciding to call each other, rather than send cards, becauseof the dropping costs of long distance.
The business planners for Britaand PUR water filters, likewise, have less to gain from poaching each others customers than they do from drawing clients the vast majority of people who get their water right from the tap.
Those are just two of many examples offered Saturday by John Murry, a marketing professor from the University of Iowas Tippie College of Business, to about 50 students from UIs Carver College of Medicine.
You are going to find yourself competing with people who look different than you, Murry told the students, shortly before the mornings first break.
Murrys marketing presentation was part of a half-day seminar designed to get the future internists, ophthalmologists, urologists and undecided specialists thinking about the various business conundrums they will face throughout their careers.
We need people who not only understand medicine and how to take care of patients but who also have a population health skill set and a business skill set, said Alan Reed, a professor of surgery and director of the Organ Transplant Center at UI Hospitals and Clinics. People who know how to get data from a financial statement and put that information to good use.
When Reed graduated medical school in the 1980s, he said physicians had really punted on being leaders in health care.
University of Iowa professor John Murry leads a seminar for medical school students at the Beisner Auditorium in the Bowen Science Building on Saturday, Feb. 11, 2017.(Photo: David Scrivner / Iowa City Press-Citizen)
Slowly but surely, physician leadership is becoming a more important part of the health care landscape, he said, pointing to the expansion of UIHC under the physician leadership of Jean Robillard, a professor of pediatrics and UI's outgoing vice president for medical affairs.
Reed went back to school himself and earned an MBA from UI in 2012.
It opened up a whole new avenue for me, he said.
So when a handful of medical students came to Reed asking for more exposure to business case studies, he worked with them to develop a new, three-year distinction track program to offer to medical students on a continual basis.
We thought these concepts were important and werent as represented as much as we would like them to be, said Charlie Paul, a fourth-year medical student who majored in finance as an undergraduate.
Paul said and his colleagues had kicked around various ideas, but they eventually settled on the quarterly, half-day seminar as a way to fit the sessions into medical students' busy schedules. The Carver College of Medicine already offers a few distinction track options for students, so the format would be sustainable year after year.
This isnt an MBA; it's not an advanced degree, Paul said. But as Dr. Reed says, it whets everyones appetite. It exposes students to these concepts and provides resources for reading more about them and for getting involved with larger projects.
Paul also stresses that the focus of the class isnt on treating individual patients as some sort of business commodity; its about preparing doctors for the business decisions they will have to make.
Those are separate and both very different and challenging problems of the health care industry, Paul said. You cant sacrifice patient care for the bottom line, but you also do yourself a disservice if youre not thinking about how to keep the lights on and how to keep patients happy. Its not in the patients best interest to not having the operating room running efficiently and on time.
In addition to Saturdays discussion of marketing, previous half-day seminars have focused on e-health and managerial accounting.
Instead of just learning how to practice medicine from a purely science- and patient-based point of view, Im also learning about how to consider the other external factors that are going to shape and influence and really dictate the way that I practice medicine, said Kelsey Adler, a first-year medical student from the Chicago area.
Medical school students follow along as University of Iowa professor John Murry holds a seminar at the Beisner Auditorium in the Bowen Science Building on Saturday, Feb. 11, 2017.(Photo: David Scrivner / Iowa City Press-Citizen)
The lesson Adler learned Saturday, she said, was to keep her eyes on those external forces.
You cannot just make decisions on your own experience, with only the perspective you have from your professional background, Alder said.
Lizzy Gerdis, a third-year medical student from Waukee, said she learned much from the previous seminars, but she arrived Saturday morning questioning whether a four-hour discussion of marketing would be helpful for her.
Her opinion changed as soon as Murry began his presentation.
I guess sometimes I dont really know what Ill be interested in until Im here, Gerdis said.
Reach Jeff Charis-Carlson at jcharisc@press-citizen.com or 319-887-5435. Follow him on Twitter at @JeffCharis.
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UI teaching future doctors the business of medicine - Iowa City Press Citizen
CHAMBERSBURG, Pa. - Tuesday evening many in Chambersburg came to the Eugene C. Clarke community center where they could learn more about Virdis Medicine. Daniel Kearns is the managing operator for the company and says their goal is to provide medications to people in need.
There are 17 qualifying conditions, things like cancer, HIV, PTSD, epilepsy, so you have to have medical documentation that you have one of these conditions and you obviously have to get the recommendation from a physician, said Kearns.
During his presentation, he outlined that they were interested in Chambersburg because of it's location in South Central Pennsylvania.
When you look at the South Central Zone in Pa, Franklin County is in the middle and there are going to be a lot of counties in the South Central zone that don't receive a dispensary and we want to make sure that everyone in the zone has access to the medication, said Kearns.
Once Kearns was done with his presentation, people had the chance to both comment and ask questions. Deb and Richard Miller have a 35-year-old son who is autistic, and they believe their son could benefit from medical marijuana.
He's on very powerful medications right now, which have had some significance side affects and some of the research; I used to be a medical librarian indicates that medical marijuana would be helpful with someone with autism, said Deb Miller.
Karen Diller has a 20-year-old daughter who has struggled with seizures most of her life. She gave a personal testimony about how medical marijuana worked for their family and knows it will help others.
I know several people with situations such as ALS, cancer, MS, different things that I know people that really need to try this because it could be a life changer, it certainly has for us, said Diller.
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CHAMBERSBURG, Pa. - In Chambersburg, the council met Monday night where they had the chance to hear a presentation from Virdis Medicine, the medical marijuana industry that is seeking a permit to operate a medical marijuana dispensary in the borough.
During the meeting, the company briefly outlined what the process would be for them to come to Chambersburg. They also explained what serious conditions must be met for a person to use medical marijuana. The borough believes that facility could be very beneficial to the area.
This is one of several companies that have contacted the borough of Chambersburg. They seem to be further along with the other folks that we have talked to us and I believe they'll if anybody stands a pretty good chance at getting it will probably be them, said Allen Coffman, Borough council president.
Virdis Medicine will give a more detailed presentation Tuesday at 7p.m. at a town hall meeting at the Eugene C. Clarke Community Center in Chamberbsburg.
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Chambersburg Council hears a presentation from Virdis Medicine at Monday's council meeting - WHAG
One morning in 1952, when anesthesiologist Dr. Virginia Apgar was eating breakfast in a hospital cafeteria, a medical student commented on the need for a way to assess how well a baby has endured delivery. Dr. Apgar immediately wrote down five evaluation criteria: breathing, heart rate, muscle tone, reflexes, and skin color.
One year later, Dr. Apgar suggested that using these five criteria to generate a score is an effective way to determine which babies are likely to need medical attention after birth.
"A practical method of evaluation of the condition of the newborn infant 1 minute after birth has been described," she wrote in her 1953 proposal paper. "A rating of 10 points described the best possible condition with two points each given for respiratory effort, reflex irritability, muscle tone, heart rate and color."
This method was soon coined the "Apgar score," and the technique was rapidly adopted by clinicians across the globe.
In the first of a series highlighting female role models in medicine, we explore Dr. Apgar's life, career, and lasting legacy, particularly as they apply to healthcare professionals today.
Dr. Apgar's list of achievements is impressive. She was the first woman to direct a division at Presbyterian Hospital, the first woman to become a full professor at the College of Physicians and Surgeons of Columbia University, and the first woman to devise a critical tool for neonatal care, to name but a few.
She was also a great advocate for patients. Her relatively simple solution to an unmet clinical need made a key contribution to reducing infant mortality rates.
Importantly, the Apgar score also had a lasting effect on changing the perception of newborn babies. Previously viewed as a byproduct of birth, newborns were now at the center of care in the delivery room.
More than 60 years on, despite significant advances in technology, the Apgar score remains the first medical assessment of a newborn baby.
But why has Dr. Apgar's solution persisted, and what can modern clinicians learn from her approach?
Dr. Apgar graduated from Columbia University College of Physicians and Surgeons as an M.D. in 1933, as one of just nine women in a class of 90.
Despite her promising surgical skills, she specialized in anesthesia, as career opportunities for women in surgery were limited at the time.
Following her training, Dr. Apgar became the director of the newly established Division of Anesthesia at the New York-Presbyterian Department of Surgery - the first woman to hold such a position.
In 1949, Dr. Apgar became a professor of anesthesiology at the Columbia University College of Physicians and Surgeons, making her the first woman to hold a full professorship at the university.
As a professor, she was able to focus more of her attention on research. It was during this time that she developed her interest in obstetric anesthesia, which was an understudied field of medicine.
Dr. Apgar's breakthrough was to follow shortly.
Though it may seem that the Apgar score was a spur-of-the-moment creation in a hospital cafeteria, evidence suggests that there was much more thought behind its development.
In 1950, there were more than 20 neonatal deaths per 1,000 live births in the United States, and Dr. Apgar was concerned by these figures.
Anoxia - primarily due to obstetric anesthesia - was to blame for the majority of neonatal deaths. However, in the delivery room, the presence of medical staff who were skilled in anesthesiology and resuscitation was sparse.
Furthermore, there was no consensus on what a "normal" newborn state was, nor were there any measures in place to determine which newborns required resuscitation.
The Apgar score filled this void, providing five criteria that clinicians could use to determine a baby's condition 1 minute after birth and whether they required medical assistance.
Most importantly, and as Dr. Apgar herself stated, the Apgar score "gets people to look at the baby." Finally, newborn babies were getting the attention they deserved.
As noted in the March of Dimes archives:
"In essence, the Apgar score was revolutionary because it was the first clinical method to recognize the newborn's needs as a patient. It helped spur the development of neonatology as a medical focus, establishing the need for protocols and facilities such as the newborn intensive care unit to provide specialized care."
By the early 1960s, the Apgar score was in use at many hospitals across the U.S.
Dr. Apgar pointed out in a review in 1966 that "five [signs] were chosen which could be evaluated without special equipment and could be taught to the delivery room personnel without difficulty." It is not surprising that the Apgar score quickly gained popularity, being easily implemented in delivery rooms worldwide.
Today, it remains the "gold standard" of newborn evaluation.
The past 60 years have seen some significant advances in neonatal care, such as the introduction of mechanical ventilation and surfactant replacement therapy.
Unsurprisingly, attempts have also been made to improve the Apgar score. In 2010, researchers from Stanford University reported the creation of what they claim is a more "reliable, electronic version of the Apgar score," called PhysiScore.
When tested in preterm babies, PhysiScore demonstrated greater accuracy than the Apgar score, according to study results.
Whether PhysiScore or another form of neonatal assessment will one day supersede the Apgar score remains to be seen, but it seems that its simplicity is holding it in good stead.
"Its convenience, ease of use and applicability in identifying babies that need immediate support helps explain its endurance," Dr. Yasser El-Sayed, of the Department of Obstetrics & Gynecology - Maternal Fetal Medicine at Stanford and member of the American Congress of Obstetricians and Gynecologists, told Medical News Today.
"[...] several investigators have proposed adding to or changing the Apgar score, but so far there hasn't been a major effort to do so," noted Dr. Kristi Watterberg, professor of pediatrics and neonatology at the University of New Mexico and a member of the American Academy of Pediatrics.
"I think that it's so well-known and relatively easy to perform (even though subject to individual variation) that it would be hard to easily change," she told MNT.
The development of the Apgar score inspired a wealth of research related to the prevention and treatment of birth defects, much of which Dr. Apgar was involved in.
In 1959, she became director of the division of congenital defects at the National Foundation for Infantile Paralysis (now known as March of Dimes) - a position she held until her death in 1974.
"She also popularized use of the term 'birth defects,' which was more accessible to the public than the medical term 'congenital anomalies,' used by doctors," Dr. Edward R.B. McCabe, chief medical officer of the March of Dimes, told MNT.
"Drawing national attention to birth defects led to the recognition that these conditions are significant contributors to infant mortality," he added. "Dr. Apgar's work at the March of Dimes led to nationwide activities to prevent birth defects and thus reduce infant mortality."
By finding a practical solution for communicating complex medical problems to the public, Dr. Apgar once again demonstrated how a change in perception can have a profound impact on health.
Despite practicing medicine at a time when gender inequality was at a peak, Dr. Apgar claimed that being a woman had not posed any serious limitations on her career.
"Women are liberated from the time they leave the womb," she once said, explaining her decision not to take part in the women's movement.
Behind closed doors, however, Dr. Apgar sometimes spoke of her frustration surrounding disparities among men and women in medicine, particularly when it came to differences in pay - an imbalance that remains evident to this day.
"She was a remarkable woman," Dr. Watterberg told us. "She provided a powerful role model for women in medicine."
Since 1950, the neonatal death rate in the U.S. has fallen dramatically, standing at around 5 per 1,000 live births in 2010.
While the improvement in neonatal survival cannot solely be attributed to Dr. Apgar, there is no doubt that her work played a significant role, and it continues to be pivotal in neonatal care and research.
Her approach to innovation speaks of empathy for the patient and a drive to develop practical solutions that not only raise awareness and change perception, but that can also be effectively translated into clinical practice.
By designing the Apgar score in a way that could be easily implemented in delivery rooms worldwide, Dr. Apgar demonstrated that simple solutions, capable of addressing complex problems, can stand the test of time.
"She [...] left us a lasting tool, the Apgar score, providing a structured approach to evaluate newborns. Her score serves as a common language among the various specialties, including anesthesiology, that care for newborns.
Her score led to better treatment of newborns and to great advances in anesthesia for their mothers. Her score was a unique contribution to anesthesiology, to maternal and child health, and to a generation of researchers dedicated to improved neonatal outcomes."
Dr. Selma H. Calmes, David Geffen School of Medicine, UCLA
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Dr. Virginia Apgar: Changing perceptions in medicine - Medical News Today
The villagers gather in Pampa Hermoza.
The villagers of Pampa Hermoza, Peru, gathered in the wooden bleachers on the local football field, their faces turned toward the sky and their legs dangling freely over the ground below.
On this late December afternoon, they hoped to witness the first cargo drone delivery of antivenom to their remote settlement in the Amazonian rainforest. At first they were excited, but as time passed and the drone didn't show, they grew anxious.
Even more frustrated was Patrick Meier, executive director and co-founder of WeRobotics, a global nonprofit employing drones and robotics for humanitarian causes. Meier worked for months with the Peruvian government, his own local Flying Labs team, Peru's aviation authority and a US drone startup to get this test up and running.
Getting the project to work could be a lifesaver. Local doctors in the region report up to 45 snake bites, many of which are life threatening, every month among thousands of indigenous communities. Delivering the right antivenom can take hours by boat and foot, which is why WeRobotics and the Peruvian Health Ministry were keen to find out if cargo drones could realistically complete the task in a fraction of the time.
It's yet another potential application for drones, which have gone from being military tools to Lady Gaga 's backdrop at the Super Bowl. In Japan, researchers are developing drones that pollinate flowers, augmenting a declining bee population.
Drones are everywhere, cheap enough for you to buy on Amazon for your kid, and smart enough that retailers like Amazon are testing them for deliveries. The drone market is expected to nearly double to $11.2 billion by 2020, according to Gartner.
Beyond antivenom, WeRobotics has research teams in Peru, Tanzania and Nepal to explore other uses for drones, including combating the spread of the Zika virus.
Some drones are already providing health care in remote regions, especially for disaster relief scenarios, according to Stelios Kotakis, an analyst from IHS Markit. The growth will largely depend on the outcome of projects currently in the "experimental stage," he said.
For WeRobotics, its field test in Peru can be chalked up as a success -- albeit in a slightly roundabout way.
Just as Meier began to lose hope, the villagers started calling his name. A speck appeared on the horizon. The drone finally arrived -- five minutes later than expected. The flight took 35 minutes.
Children clapped and cheered as it swooped in and skidded smoothly across the grass. "There's video of me jumping up and down a dozen times and yelling hooray, hooray, hooray," Meier said.
He had good reason to be relieved.
The few days prior were rife with frustrations as the original $40,000 vertical takeoff and landing drone that arrived from North America failed to complete even one of the many dozens of planned flights.
Fortunately, there was a plan B.
Franky may not be pretty, but at least it can fly.
The team happened to bring an old $3,000 mapping drone along for the ride to the home base of Contamana, a six-hour riverboat journey from Pampa Hermoza. Battered, bruised and covered in gaffer tape, the mapping small fixed-wing drone, an Event 38 E384, was in such a state that Meier's staff nicknamed it Franky, after Frankenstein's monster.
For well over a year, Franky had been flying over the rainforest mapping and monitoring its environment. Fortuitously, the space housing the camera was exactly the right size to fit the mini cooler carrying the antivenom. With a few minor modifications, Franky suddenly had a new job.
There was only one problem: Franky had never flown more than 10 kilometers before, and it needed to go four times the distance.
"We had zero idea that this would work and zero guarantees," said Meier. The team decided to press on. "We might as well go all out."
By making it safely to Pampa Hermoza that day, Franky showed that there's hope for delivery drones to play a role in delivering health care in the Amazon.
"The use of the technology will be crucial in the future to improve access to health services, in particular highly specialized services," said Dr. Leonardo Rojas, former executive director of telemedicine at the Ministry of Health in Peru.
But the plucky little engine that could hadn't finished demonstrating what it was capable of.
A return flight was planned. Franky was supposed to deliver a vial of blood for testing back at the hospital in Contamana. Meier and his colleagues swapped in a fresh battery for the return journey.
It was getting late. There were no records of any cargo drones being flown successfully at night over the Amazon. It didn't deter Meier and his team. "We figured we might as well go for gold here," he said.
They strapped a bike light to Franky's nose with yet more gaffer tape.
Just as the team was ready to launch, it realized Franky wasn't connecting to the base station back in Contamana, through which its flight path was programmed. A debate ensued. There was a small chance that if the drone got enough altitude it would manage to connect, said Juan Bergelund, Meier's counterpart back in Contamana.
Meier wasn't so sure.
Franky takes a tumble.
"Even the other Peruvians were saying, 'Are you kidding me?'" said Meier. "We're going to lose the drone, we'll never recover it."
But Bergelund made the call and Franky flew into the darkness.
"All we see is this blinking drone fly off through the night." said Meier. "At this point it was beyond surreal, we were asking for trouble."
Bergelund's bet paid off, and Franky connected to the base station. But due to a slight miscalculation of the GPS coordinates, the drone ended up in a fight with a coconut tree near the field in Contamana.
If such an entanglement had occurred when testing the original $40,000 drone, it could have cost thousands of dollars to repair the damage, Meier said. For Franky, it meant -- yep -- another gaffer tape job and a $3 replacement part. The vial of blood stashed inside was unharmed.
Franky's success provided the whole team with a much-needed reality check on the approach it was taking to cargo drones.
"This awesome, humble Peruvian team had pulled off with just a few thousand dollars in a few hours what a major company had failed to pull off after a few months of planning with a drone that cost more than 10 times that price," Meier said
The Peru Flying Labs team saved the day with Franky the mapping drone.
The report on the field tests, published Monday, concludes that for the price of the original $40,000 drone, WeRobotics could buy 11 E384 Franky-style drones, establishing a whole delivery network. Neither the report, nor Meier, would disclose the US startup that built the original drone.
But two successful flights are not enough on their own to justify building such a network. The team is out in Contamana conducting further tests, this time using E384 UAVs from the get-go. Presuming they are successful, they will conduct further tests in May that will see them push the range up to 100km.
Beyond the Amazon test, WeRobotics is exploring fighting Zika by using its drones to release millions of sterilized, male mosquitoes into an environment where they will compete with local populations to mate with females, reducing the numbers of insects in the subsequent generation.
WeRobotics will have to use larger drones, but it has learned its lesson about the kind of technology it employs.
"It doesn't have to be sexy, it doesn't have to cost $40,000," Meier said. "As long as it works, that's good enough."
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This medicine-toting drone flew where no one thought it could - CNET
Mia Jones helped her YMCA-director father raise money for needy children to take part in Y activities.
Kathryn Pearson Peyton played violin for residents of a retirement home.
Susan Towler was a child-care volunteer at the Happy Acres Ranch.
Other families go outside and play football, said Annie Egan. We did community service.
They are among 12 Northeast Florida women who trace their charitable tendencies to their youth, when their parents and families set an example of helping others. Volunteers in Medicine Jacksonville, a nonprofit clinic largely staffed by volunteers, honored them at a recent luncheon as Women With Heart who champion health-care access, kicking off a unique year-long fundraising campaign.
Philanthropist Delores Barr Weaver, a longtime donor who gave the clinic two $100,000 challenge grants in the past year, was given the inaugural Dorion-Burt Heart of Gold Award, named after the clinics founders. Each of the other 11 women honored Jones, Pearson Peyton, Towler and Egan, along with Aimee Boggs, Paula Liang, the Rev. Kate Moorehead, Helen Morse, Nicole Thomas, Lisa Weatherby and Tracy Williams will spend a different month in 2017 working to increase public awareness about Volunteers in Medicine and financial support for its mission.
How they customize that month of advocacy is up to them, said clinic CEO Mary Pat Corrigan. As a conversation starter during their respective month, each will wear the $7,000 diamond heart necklace designed exclusively for the cause by Beards Jewelry. At next years luncheon, the necklace will go home with the winner of a drawing. Also, at the luncheon they received an exclusive Bacardi rum made in their honor.
With their individual circles of influence, we believe we will significantly increase the recognition of the valuable work we are doing to keep our vulnerable, hard-working and uninsured families and individuals healthy, employed and out of our hospital emergency rooms, Corrigan said.
Volunteers in Medicine provides free health care to low-income, uninsured working adults and their families at a full-service downtown clinic funded by grants and donations.
About 230 volunteers including 70 physicians and nurse practitioners from all the major area hospitals annually provide about $1.2 million worth of primary and specialty care, dental and eye care, mental-health and nutritional counseling, among other services. Also, the clinic is a learning ground for nurse practitioners, resident physicians and other health-care professionals in training at area colleges and hospitals.
In 2002 founders Dottie Dorion and Jim Burt saw the need for health care for the working poor. Dorion was a registered nurse, founder of Community Hospice of Northeast Florida and philanthropist; Burt, a recently retired urologist who was long active in community affairs and advocacy for the medically underserved. After a year of planning, fundraising and overseeing renovation of an old Salvation Army building, they opened the clinic in 2003.
I wanted to do something for the community to help people who were finding it hard, Burt said.
Even though the working poor had jobs in some cases, two jobs many of them still could not afford health care for themselves and their families, he said.
They dont fit into the [health care] system, he said.
Over the years, the clinic has received grants and donations that allowed us to stay open and keep up with patient care, Dorion said.
We had the good fortune to be supported by many people who shared our vision, she said, citing Weaver in particular as providing game changing funding last year when it was needed most. Weavers two 2016 grants not only helped the nonprofit achieve financial stability, but enabled us to expand our services, according to board chairman Cory Meyers.
Florida Blue, which hosted the luncheon at its Deerwood Campus conference center, is also a longtime supporter, said Darnell Smith, North Florida market president.
Everybody deserves access to good health care, he said at the luncheon.
Also, he said the 12 Women With Heart deserve recognition for their collective good works.
Each has demonstrated compassion, dedication and commitment to help better our community, Smith said. They demonstrate integrity.
The honorees each said community service was an integral part of their lives. Liang recalled a teacher who made her realize it was OK to be smart and a girl, which led to her going to Brown University and law school.
How could I not pay that forward, she said.
Williams said when she sees an injustice, I have to help.
I truly believe we are here to take care of each other, she said.
When we follow God, Moreland said, we are all capable of miracles.
Beth Reese Cravey: (904) 359-4109
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'Women With Heart' to advocate for Volunteers in Medicine - Florida Times-Union
Science Daily | Corn, milk proteins make medicine easier to swallow -- ScienceDaily Science Daily It's all about the layers, say scientists. Encapsulating a drug in corn protein nanoparticles and then covering with them milk protein can make children's ... |
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Corn, milk proteins make medicine easier to swallow -- ScienceDaily - Science Daily
Healthcare IT News and HIMSS are accepting speaker proposals for the inaugural Precision Medicine Summit, June 12-13 in Boston.
This event will give attendees a valuable state of the industry for precision medicine. Over two days, speakers will discuss the current state of precision medicine, the ultimate goal, and what the healthcare industry must to do reach that goal.
Audience and speakers will include a mix of clinicians, health IT professionals and researchers at academic medical systems, hospitals, physician practices, government andacademic institutions.
Session proposals should focus on how healthcare organizations are using precision medicine to deliver targeted, personalized care. Specific topics could include: the vendor and reimbursement landscapes, ethical issues, building data bases, managing unstructured texts, privacy & security, data use and migration, among others.
Case studies are a priority for this event.The deadline for submitting a proposal is 5 p.m., Friday, Feb. 17, 2017.
Click here to submit a proposal and for more information.
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HIMSS Precision Medicine Summit: Call-for-presentations now open - Healthcare IT News
San Francisco Examiner | The Father of Electrical Medicine San Francisco Examiner The early 20th Century was a time of great developments and competing theories in medicine. Electricity was still a new discovery and it was thought by many to have curative powers. Alternative medical approaches, such as chiropractics and osteopathy ... |
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A A
SPOKANE Medical education is booming in Spokane.
A new medical school by Washington State University plus a dramatic expansion of a modest medical training program operated by the University of Washington mean hundreds of future doctors will soon be training in the eastern Washington city.
Its the culmination of years of efforts by civic leaders to expand education offerings that have the potential to grow the economy.
The most high-profile development is Washington State Universitys creation of the Elson S. Floyd College of Medicine, the nations newest med school.
Named for the late WSU president who pushed for its creation, the Floyd College received preliminary accreditation in October and has started accepting applications for its first class. The school plans to enroll 60 students per class, with the first class starting in August.
WSU President Kirk Schulz said the accreditation news puts us one step closer to educating physicians who will practice in Washingtons underserved communities and furthers the universitys land-grant mission to serve the needs of the state.
Getting less attention but just as significant, is the University of Washingtons decision to expand its medical training in Spokane.
The university has long operated the states only public medical school. For years, it placed about 20 medical students per year in Spokane as part of its WWAMI program that trains doctors for the states of Washington, Wyoming, Alaska, Montana and Idaho.
But the University of Washington expanded that program last fall to 60 first-year students in Spokane.
Now the UW is asking the Legislature for more than $9 million, so it can train a total of 80 medical students per class in Spokane.
We have created something very special in Spokane for Spokane, said Mari Clack, of the Friends of WWAMI, a group of community leaders formed to support UW students in Spokane. This region needs more doctors to serve our aging population.
The UW School of Medicine partners with Gonzaga University to provide the training in the Lilac City.
The goal is to reduce the shortage of doctors, particularly in rural and underserved areas. Half the states doctors work in the Seattle region, while many parts of the state do not have enough physicians.
The first step toward addressing a physician shortage is to educate more medical students, and especially those students who are interested in practicing rural medicine, said Dr. Suzanne Allen, vice dean for Academic, Rural and Regional Affairs for UW.
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